Cardiovascular disease (CVD) accounts for more than one-third of all U.S. deaths and a major source of racial/ethnic and socioeconomic health disparities. Rising child and adolescent obesity rates threaten to erase the prior success of CVD prevention efforts. Without significant improvements in prevention, CVD prevalence is likely to increase by 10%, and related healthcare costs are likely to triple by 2030. Obesity and hypertension are major contributors to CVD risk and major sources of racial/ethnic and socioeconomic disparities over the life course. Low-income African Americans are particularly vulnerable. Despite the availability of: 1) behavioral interventions addressing diet and physical activity as mainstays of obesity and CVD risk reduction, and 2) research evidence suggesting that family-level interventions may be important for eliminating child and adolescent CVD and obesity disparities; most adult CVD risk reduction interventions do not consider family- level effects. The goal of the proposed research is to develop an innovative and effective family-level intervention targeting adolescent family members of African-American (AA) adults at high-risk for CVD. This research will: 1) identify mechanisms by which an individual-level CVD risk reduction intervention can produce family-level effects, 2) yield an innovative family-level intervention that is likely to reduce adolescent CVD and obesity risk among high-risk AA youth, and 3) generate valuable pilot data for a future R01 proposal to inform refinement and evaluation of the family-level intervention developed via this proposal. This research is a critica step in developing effective and innovative family-level interventions with significant positive impacts on CVD and obesity disparities among high-risk adolescents. It also represents a critical next step in the scholarly development of the candidate for this Mentored Patient-Oriented Research Career Development Award (K23). The candidate for this K23, Dr. Rachel J. Thornton, is a general pediatrician and Assistant Professor of Pediatrics at Johns Hopkins University School of Medicine. Her long-term career goal is to become an independently funded patient-oriented researcher studying development, implementation, evaluation, and dissemination of multilevel interventions to eliminate racial/ethnic and socioeconomic disparities in child and adolescent CVD and obesity risk. During the award, Dr. Thornton will complete a rigorous program of training, including advanced coursework and practical research. Her proposed activities will occur within the rich training environment of the Johns Hopkins Medical Institutions and Johns Hopkins University including the Center to Eliminate Cardiovascular Disparities and the Johns Hopkins Global Center on Childhood Obesity. Dr. Thornton will be supported by an exceptional mentoring team, including national and international experts in intervention research, health disparities, CVD, and childhood obesity. Through the proposed K23, Dr. Thornton will develop a solid foundation in CVD epidemiology and intervention research and will be well-equipped to successfully transition into an independent, highly skilled patient-oriented researcher.